Medicare is our national health insurance program for people age 65 or older. People younger than age 65 with certain disabilities, or permanent kidney failure, or amyotrophic lateral sclerosis also known as (Lou Gehrig’s disease), can also qualify for Medicare. The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program.

The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care. You have choices on how you can get Medicare coverage.

A portion of the payroll taxes paid by workers and their employers cover most Medicare expenses. Monthly premiums, usually deducted from your Social Security checks also cover a portion of the costs.

 

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The first step to setting Medicare the right way is knowledge. Let us help you learn your basic benefits. Call Us our help is always 100% free.

Part A Covers Your Hospital Stay & Care

Part A is hospital insurance that assists you with the cost of inpatient care and skilled nursing facility stays. It also helps with things like hospice and home health care. In general, you should think of the inpatient hospital benefit as Medicare coverage for room and board in the hospital.

You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes during your working years.

The cost of Part A for most people at age 65 is $0

You can get Part A at 65 if:

  • You already get retirement benefits from Social Security or the Railroad Retirement Board.
  • You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
  • You or your spouse had Medicare-covered government employment.

If you’re under 65, you can get Part A if:

  • You have been getting Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements.

Part A premiums

If you don’t qualify for premium-free Part A, you can buy Part A.

If you buy Part A, you’ll pay up to $471 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $471. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $259.

In most cases, if you choose to buy Part A, you must also:

  • Have Medicare Part B (Medical Insurance)
  • Pay monthly premiums for both Part A and Part B

Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Part A late enrollment penalty

Some people have to buy Part A because they don’t qualify for premium-free Part A. If you have to buy Part A, and you don’t buy it when you’re first eligible for Medicare, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.
Limited Income and Extra Help
If you have limited income and resources, State of Nevada may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.

 

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Do you need help understanding Medicare coverage? Let us help you learn your basic benefits. Call Us our help is always 100% free.

Part B Covers Your Doctors & Outpatient Services

Medicare Part B is your outpatient medical coverage. Part B covers essentially all of your other coverage outside of your inpatient hospital fees. If you do not have Part B, you would be uninsured for doctor’s visits (including doctors who treat you in the hospital). Your lab work, preventive services, and surgeries. Would also not be covered by Medicare.

Part B is also what covers cancer therapy and kidney dialysis. Without coverage these types of medical services can be very costly and bankrupt anyone.

The cost of Part B is set by Social Security and it changes from year to year. Individuals in higher income brackets pay more than those in lower incomes brackets. How much you pay is determined by your adjusted gross income reported to the IRS in recent years.

What Part B Covers?

Part B covers 2 types of services:

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment. Call us and we can go over the preventative services that are available from the carriers in Nevada.

Part B also covers things like:

  • Clinical Research
  • Ambulance Services
  • Durable Medical Equipment (DME)
  • Mental Health
  • Inpatient
  • Outpatient

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Do you need help understanding Medicare coverage? Let us help you learn your basic benefits. Call Us our help is always free.

Medicare Advantage also called Part C

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare (Government). They are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These “Bundled” plans include  Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance, and usually Medicare prescription drug (Part D).

To enroll in a Part C plan, you must be enrolled in both Medicare Parts A and B.

You must live in the plan service area.

The most important element of  Medicare Advantage or Part C is that it is not Original Medicare (Government). It is an alternative to Original Medicare and is managed by private insurers. This means that once you enroll, your Medicare coverage will come from the Advantage plan itself, and no longer from the government.

 

There are 2 ways to get medicare:

  1. Original Medicare (Government) 80% + Medicare Supplement (Private Insurance Companies) 20% + Prescription Drug Plan (Private Insurance Companies)
  2. Medicare Advantage (Private Insurance Companies)

This is a choice whether you wish to join a Medicare Advantage Plan or just stay with your original Medicare A & B and enrolling in Medicare Supplement Plan. Call us and we can help you determine the best path that will work for you.

 

Who provides coverage?

Private insurance companies approved by Medicare like UnitedHealthCare, Humana, Anthem, Aetna, etc.

 

How come I do not enroll in it at Social Security like A & B?

Because Part C is voluntary. Some people prefer to get their Medicare coverage from Original Medicare (Government) and traditional Medicare Supplement plans. Others do not mind being in a network and like having just one plan that includes all of the services provided by Original Medicare, Prescription Drug Plan, Dental, Vision and other Wellness benefits all wrapped into one plan with one monthly premium.

 

How do you choose your providers?

We can help you determine the best plans in your area and personalize it to your needs. You choose the one the works best for you.

 

How much does it cost?

  • You usually pay a low to no monthly premium for your MA Plan (in addition to your monthly Part B premium).
  • You may pay a co-payment or coinsurance for covered services. Many MA plans offer vision, hearing, and dental coverage. Costs, extra coverage, and rules vary by plan.
  • Plans have a yearly limit on your out-of-pocket costs. Once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year.
  • Your out-of-pocket costs may be lower in an MA plan.

 

Medicare Advantage Plans cover all Medicare services

Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care.

The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

Most Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and wellness programs (like gym memberships). Plans can also cover more extra benefits including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, meal plans, and other health-related services that promote your health and wellness.

Plans can also tailor their benefit packages to offer these new benefits to certain chronically ill enrollees. These packages will provide benefits customized to treat those conditions. Check in with us to see what benefits are offered on every plan available in Nevada.

Most include Medicare prescription drug coverage (Part D).

 

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D).

You may be able to join a stand-alone prescription drug plan if you enroll in a plan that does have prescription drug plan:

  • Can’t offer drug coverage (like Medicare Medical Savings Account plans)
  • Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these occur:

  • You move out of the plan’s service area.
  • You join a separate Medicare Prescription Drug Plan.

 

 

Get More Medicare Information

The first step to setting Medicare the right way is knowledge. Let us help you learn your basic benefits. Call Us our help is always 100% free.

Medicare and Medicaid are two separate, government-run programs. They are operated and funded by different parts of the government and primarily serve different groups.

  • Nevada Medicaid is a Nevada state-run program that provides hospital and medical coverage for people with low income.is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.
  • Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income.

If you are eligible for both Medicare and Medicaid (dually eligible), you can have both. They will work together to provide you with health coverage and lower your costs. In this case, Medicare is primary and Medicaid is secondary.

Also know that while Medicare and Medicaid are both health insurance programs administered by the government, there are differences in covered services and cost-sharing. Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible.

The government has several Savings Programs which you can apply for through Nevada’s Medicaid office.  These may help you to pay your Part B premiums. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.

Do You Qualify To Have Your Medicare Part B Premium Paid For By The State Of Nevada?

If you do, you will receive your $148.50 back into your Social Security Check. You may also qualify for the Extra-Help program from Social Security.
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